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f) ) ~) ) If a Member does not follow the access rules, he risks having the services and supplies received not covered under this Contract. In such a circumstance, any payment that AvMed may make will not exceed the Maximum Allowable Payment and the Member will be responsible for reimbursing AvMed any Maximum Allowable Payment rnade for the services and supplies received. The following services require prior authorization from AvMed: . Inpatient admissions . All Home Health Care Services . Complex diagnostic procedures . Surgical procedures or services performed in an outpatient Hospital, Hospital-affiliated ambulatory surgery center, or free-standing ambulatory surgery center . All medications administered in an outpatient Hospital or infusion therapy setting . Select medications administered in a physician's office . Care rendered by Non-participating Providers (except for Emergency Medical Services and Care) . Transplant services . Dialysis services Forrnore information about which services require prior authorization, contact AvMed at 1-800-882-8633. \Vithin the Service Are~ Members are entitled to receive the covered services and benefits only as herein specified, appropriately prescribed or directed by Participating Physicians. The covered services and benefits listed in the section entitled Schedule of Basic Benefits are available only from Participating Providers within the Service Area and, except for Emergency Medical Services and Care as provided in Section 10.11, AvMed shall have no liability or obligation whatsoever on account of services or benefits sought or received by any Member from any Non-participating Provider, or other person. institution or organization, unless prior arrangements have been made for the Mernber and confirmed by written referral or authorization from AvMed. The names and addresses of Participating Providers and Hospitals are set forth in a separate booklet which, by reference, is made a Part hereof. The list of Participating Providers, which may change from time to time, will be provided to all Subscribing Groups. The list of Participating Providers may also be accessed from the AvMed Website at www.avmed.org. Notwithstanding the printed booklet, the names and addresses of Participating Providers on file with AvMed at any given time shall constitute the official and controlling list of Participating Providers. Pursuant to Florida Statute, there is a link available on the AvMed Website to view the performance outcome and financial data that is published by the Florida Agency for Health Care Administration. Each Member shall select one Primary Care Physician upon enrollment. If you do not select a Primary Care Physician upon enrollment, AvMed will assign one for you. You must notify and receive approval from AvMed prior to changing your Primary Care Physician. Such change will become effective on the first day of the month after you notifY AvMed. You cannot change your Primary Care Physician selection more than once per month. Health Professionals may from time to time cease their affiliation with AvMed. In such cases, you will be required to receive services from another participating Health Professional. MEMBERS ARE RESPONSIBLE AND WILL BE LIABLE FOR CO-PAYMENTS WmCH MUST BE PAID TO HEALTH CARE PROVIDERS FOR CERTAIN SERVICES, AT THE TIME SERVICES ARE RENDERED, AS SET FORTH IN THE SCHEDULE OF BENEFITS. 10.01 Ambulance services as follows: 10.01.01 Local professional air/ground ambulance transport for emergency services to the nearest emergency department appropriately staffed and equipped to treat a medical condition; 10.01.02 Ground transportation to an alternative level of care when associated with an approved Hospital confinement; and 22 A V -Gl 00-2009 MP-5319 (10/09)